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Book ; Online ; Thesis: Personalisierte Therapiekonzepte in der spinalen Neurochirurgie

2021

Author's details	Sebastian Robert Siller
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Universitätsbibliothek der Ludwig-Maximilians-Universität
Publishing place	München
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article ; Online: Large symptomatic sacral Tarlov cyst in a paediatric patient: case report and technical note on a new variation of surgical technique to overcome one-way check-valve mechanism.

Siller, Sebastian / Funnell, Jonathan P / Bishop, Tim / Lui, Darren / Bernard, Jason

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

2024

Abstract: Purpose: Symptomatic Tarlov cysts in children with a possible underlying one-way check-valve mechanism are very rare. We aim to introduce a new variation of the surgical technique to overcome a check-valve mechanism.: Methods: A 15-years-old girl ... ...

Abstract	Purpose: Symptomatic Tarlov cysts in children with a possible underlying one-way check-valve mechanism are very rare. We aim to introduce a new variation of the surgical technique to overcome a check-valve mechanism. Methods: A 15-years-old girl presented with double incontinence and anogenital numbness due to a large sacral Tarlov-cyst with possibly underlying one-way check valve mechanisms as suggested by preoperative computed tomography myelography. Intraoperatively, one-way check-valve was confirmed and could be eliminated by creating an artificial inner ostium between the Tarlov cyst and thecal sac with blunt perforation. Results: Postoperatively, the patient had established normal sphincter control and sensation in the anogenital region. Conclusion: One-way check-valve mechanism might contribute to the symptomatology of large sacral Tarlov cysts in children. Our new variation of a surgical technique enables elimination of the check-valve mechanism without the necessity to open and close the typically very thin and fragile cyst surface and is therefore an efficacious and simple option in this situation.
Language	English
Publishing date	2024-03-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-023-08102-8
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Article ; Online: Reducing the rate of surgical site infection using iodophor-impregnated adhesive incision draping in spine surgery compared with standard adhesive incision draping: a study in 2279 patients.

Gencer, Aylin / Schichor, Christian / Tonn, Joerg-Christian / Siller, Sebastian

Journal of neurosurgery. Spine

2023 Volume 40, Issue 2, Page(s) 248–254

Abstract: Objective: While adhesive incision drapes are widely used for reducing surgical site infection (SSI), evidence remains scarce on whether impregnated adhesive incision draping can further reduce the rate of SSI in spine surgery.: Methods: All patients ...

Abstract	Objective: While adhesive incision drapes are widely used for reducing surgical site infection (SSI), evidence remains scarce on whether impregnated adhesive incision draping can further reduce the rate of SSI in spine surgery. Methods: All patients treated surgically in the authors' high-volume university spine center from January 2018 to December 2021 were retrospectively evaluated and divided into cohorts treated before (the control cohort) and after (the study cohort) introduction of an iodophor-impregnated adhesive incision drape (instead of a standard nonimpregnated adhesive incision drape) at their institute. Epidemiological aspects, baseline characteristics, operative records, and rate and characteristics of postoperative SSI were analyzed and compared between cohorts. Results: Two thousand two hundred seventy-nine consecutively treated patients were included, with an overall SSI rate of 0.5%. Baseline patient findings and surgical characteristics (including indication, localization, procedure, and duration of surgery) did not significantly differ between the 1125 patients in the control cohort and the 1154 patients in the study cohort. Uni- and multivariate analyses showed that use of an iodophor-impregnated adhesive incision drape was the only factor significantly associated with a lower risk of SSI. The SSI rate was significantly lower in the study cohort (0.2% vs 0.8%, p = 0.036). While germs of the skin microbiome such as Staphylococcus epidermidis and S. aureus were predominantly prevalent in both cohorts, fecal germs such as Enterococcus/Enterobacter species were found only in the control cohort and not in the study cohort. Conclusions: The use of iodophor-impregnated adhesive incision drapes in spine surgery can help to lower the rate of postoperative SSI and aid in reducing the risk of fecal germ infections.
MeSH term(s)	Humans ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Adhesives ; Retrospective Studies ; Staphylococcus aureus ; Iodophors
Chemical Substances	Adhesives ; Iodophors
Language	English
Publishing date	2023-11-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2023.9.SPINE23764
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Article ; Online: Feasibility of multimodal intraoperative neurophysiological monitoring for extramedullary spinal cord tumor surgery in elderly patients.

Siller, Sebastian / Sixta, Akela / Tonn, Joerg-Christian / Szelenyi, Andrea

Acta neurochirurgica

2023 Volume 165, Issue 8, Page(s) 2089–2099

Abstract: Background/purpose: Extramedullary spinal cord tumors (EMSCTs) are mostly benign tumors which are increasingly diagnosed and operatively treated in the elderly. While there are hints that multimodal intraoperative neurophysiological monitoring (IONM) ... ...

Abstract	Background/purpose: Extramedullary spinal cord tumors (EMSCTs) are mostly benign tumors which are increasingly diagnosed and operatively treated in the elderly. While there are hints that multimodal intraoperative neurophysiological monitoring (IONM) could be influenced by age and age-related comorbidities, no study has ever systematically evaluated its feasibility and value for EMSCT surgery in elderly patients. Methods: We retrospectively evaluated all patients with microsurgical EMSCT resection under continuous multimodal IONM with SSEPs, MEPs and electromyography between 2016 and 2020. Epidemiological, clinical, imaging and operative/IONM records as well as detailed individual outcomes were analyzed and compared for the cohort < / ≥ 65 years. Results: Mean age was 45 years in cohort < 65 years (n = 109) and 76 years in cohort ≥ 65 years (n = 64), while baseline/operative characteristics did not significantly differ. Mean baseline SSEPs' latencies (left-right average) were significantly higher in the cohort ≥ 65 years for both median (20.9 ms vs. 22.1 ms; p < 0.01) and tibial nerve (42.9 ms vs. 46.1 ms; p < 0.01) without significant differences for SSEPs' amplitudes. Stimulation intensity to elicit intraoperative MEPs was significantly higher in the cohort ≥ 65 years (surrogate-marker: left-right-averaged quotient ID1-muscle/abductor-hallucis-muscle; 1.6 vs. 2.1; p < 0.001). Intraoperatively, SSEP and MEP monitoring were feasible in 99%/100% and 99%/98% for the cohort < / ≥ 65 years without significant differences in rates for significant IONM changes during surgery or postoperatively new sensorimotor deficits. Sensitivity of IONM was 29%/43%, specificity 99%/98%, positive and negative predictive values 67%/75% and 95%/93% for the cohort < / ≥ 65 years. Overall, age was no risk factor for IONM feasibility or rate of significant IONM changes. Discussion: Multimodal IONM is feasible/reliable for EMSCT surgery in elderly patients. An age-related prolongation of SSEPs' latencies and demand for higher stimulation intensities for MEPs' elicitation has to be considered.
MeSH term(s)	Humans ; Aged ; Middle Aged ; Evoked Potentials, Motor/physiology ; Evoked Potentials, Somatosensory/physiology ; Intraoperative Neurophysiological Monitoring/methods ; Retrospective Studies ; Feasibility Studies ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/surgery
Language	English
Publishing date	2023-06-24
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-023-05682-8
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Article ; Online: Unilateral Approaches for Posterior Spinal Canal Decompression in Cervical Spondylotic Myelopathy-An Evaluation of Conceptual Feasibility.

Siller, Sebastian / Pannenbaecker, Laura / Tonn, Joerg-Christian / Zausinger, Stefan

Operative neurosurgery (Hagerstown, Md.)

2022 Volume 23, Issue 5, Page(s) 431–438

Abstract: Background: Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression.: Objective: We compared the patients' outcome after 2 different unilateral and a bilateral posterior approach for ...

Abstract	Background: Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression. Objective: We compared the patients' outcome after 2 different unilateral and a bilateral posterior approach for decompression to elucidate feasibility and potential procedure-related differences. Methods: Medical records of 98 patients with CSM undergoing posterior decompression between 2012 and 2018 were assessed. Patients were divided into 3 groups: (1) unilateral interlaminar fenestration with over-the-top "undercutting" (laminotomy) for compression limited to a ligamentum flavum hypertrophy, (2) unilateral hemilaminectomy for lateralized compression with a combination of ligamentous hypertrophy and osseus stenosis, and (3) laminectomy/laminoplasty for circular osseous-ligamentous spinal canal narrowing. Results: The mean age was 73 years (m:f = 1.4:1), and most frequent symptoms (mean duration: 15 months) were ataxia (69%) and sensory changes (57%). Main location of stenoses (median Naganawa Score = 3; mean anteroposterior spinal canal diameter = 7.7 ± 2.2 mm) was C3 to C6. Thirty-one percent of the patients were assigned for a laminotomy procedure, 20% for a hemilaminectomy, and 49% for a laminectomy/laminoplasty. There were no significant differences of patients' characteristics, blood loss, and operation time between the 3 groups. Independent from the mode of surgery, the spinal canal was significantly widened (median Naganawa Score = 0; mean anteroposterior diameter = 11.4 ± 3.6 mm) and myelopathy (mJOA Score) improved ( P < .001); a higher body mass index was significantly correlated with a worse mJOA improvement (r = 0.293/ P = .003). Quality of life (Short-Form 36v2 Health Survey/Neck Disability Index) and reduction of the neck pain level were similar in the 3 groups at last follow-up (mean: 28 months). Conclusion: To minimize patients' periprocedural burden in CSM with dorsal compression, individual tailoring of the posterior approach according to the underlying compressive pathology achieves sufficient decompression and comparable long-term results.
MeSH term(s)	Aged ; Decompression ; Feasibility Studies ; Humans ; Hypertrophy ; Quality of Life ; Spinal Canal/pathology ; Spinal Cord Diseases/surgery ; Spinal Stenosis/complications ; Spinal Stenosis/diagnostic imaging ; Spinal Stenosis/surgery
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1227/ons.0000000000000364
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Article ; Online: Outcome of posterior decompression for spinal epidural lipomatosis.

Schmutzer-Sondergeld, Michael / Zimmermann, Hanna / Trabold, Raimund / Liebig, Thomas / Schichor, Christian / Siller, Sebastian

Acta neurochirurgica

2023 Volume 165, Issue 11, Page(s) 3479–3491

Abstract: Background: In contrast to osteoligamentous lumbar stenosis (LSS), outcome of surgical treatment for spinal epidural lipomatosis (SEL) is still not well defined. We present risk factors for SEL and clinical long-term outcome data after surgical ... ...

Abstract	Background: In contrast to osteoligamentous lumbar stenosis (LSS), outcome of surgical treatment for spinal epidural lipomatosis (SEL) is still not well defined. We present risk factors for SEL and clinical long-term outcome data after surgical treatment for patients with pure SEL and a mixed-type pathology with combined SEL and LSS (SEL+LSS) compared to patients with pure LSS. Methods: From our prospective institutional database, we identified all consecutive patients who were surgically treated for newly diagnosed SEL (n = 31) and SEL+LSS (n = 26) between 2018 and 2022. In addition, a matched control group of patients with pure LSS (n = 30) was compared. Microsurgical treatment aimed for posterior decompression of the spinal canal. Study endpoints were outcome data including clinical symptoms at presentation, MR-morphological analysis, evaluation of pain-free walking distance, pain perception by VAS-N/-R scales, and patient's satisfaction by determination of the Odom score. Results: Patients with osteoligamentous SEL were significantly more likely to suffer from obesity (body mass index (BMI) of 30.2 ± 5.5 kg/m Conclusions: Surgical treatment of pure SEL and SEL+LSS allows significant improvement in pain-free walking distance and pain perception immediately postoperatively and in long-term FU, similar to patients with pure LSS.
MeSH term(s)	Humans ; Prospective Studies ; Lumbar Vertebrae/surgery ; Decompression, Surgical/methods ; Spinal Stenosis/surgery ; Spinal Stenosis/complications ; Low Back Pain/surgery ; Constriction, Pathologic/surgery ; Lipomatosis/surgery ; Steroids ; Treatment Outcome
Chemical Substances	Steroids
Language	English
Publishing date	2023-09-25
Publishing country	Austria
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-023-05814-0
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Article: DTI in der Diagnostik der zervikalen Myelopathie

Schöller, Karsten / Siller, Sebastian

Die Wirbelsäule

2020 Volume 04, Issue 04, Page(s) 268–274

Abstract: Die degenerative zervikale Myelopathie (DCM) ist die häufigste Form der Rückenmarksaffektion im Erwachsenenalter. Die zugrundeliegenden pathophysiologischen Veränderungen sind komplex und eine operative Therapie ist in aller Regel spätestens dann ... ...

Abstract	Die degenerative zervikale Myelopathie (DCM) ist die häufigste Form der Rückenmarksaffektion im Erwachsenenalter. Die zugrundeliegenden pathophysiologischen Veränderungen sind komplex und eine operative Therapie ist in aller Regel spätestens dann notwendig, wenn relevante klinische Symptome einer stenosebedingten Rückenmarkskompression vorliegen. Für die Planung der Operation ist eine akkurate bildgebende Diagnostik essenziell. Diese soll dabei helfen, die zur klinischen Symptomatik beitragenden Wirbelsäulensegmente zu identifizieren. Die konventionelle Magnetresonanztomografie (MRT) ist das heutzutage am häufigsten angewendete bildgebende Verfahren bei DCM, da sich v. a. T2-gewichtete MRT-Sequenzen hervorragend für die morphologische Beurteilung der Rückenmarkskompression und die Identifikation einer Myelomalazie („Myelopathiezeichen“) eignen. Insbesondere bei multisegmentalen degenerativen Veränderungen kann die Grenze der diagnostischen Aussagekraft des MRTs jedoch schnell erreicht werden. Die Diffusion Tensor Bildgebung (diffusion tensor imaging, DTI) ist eine auf der MRT basierende, neuartige Untersuchungsmodalität, die auf der Messung der Diffusionseffekte von Wassermolekülen auf zellulärer Ebene basiert und eine Beurteilung der Integrität der weißen Rückenmarkssubstanz ermöglicht. Die beiden wichtigsten DTI-Größen, FA (fraktionelle Anisotropie) und ADC (apparent diffusion coefficient), stellen Surrogatparameter für das Ausmaß der strukturellen Myelonschädigung dar und zeigen Unterschiede zwischen DCM-Patienten und gesunden Probanden. Ein Vorteil dieser Technik könnte in einer sensitiven und frühen Detektion einer Rückenmarksschädigung liegen, zudem ist die Nutzung als prognostischer Marker oder bei der Operationsplanung denkbar. Unser Artikel beschäftigt sich mit den Einsatzmöglichkeiten des DTI bei der zervikalen Myelopathie und gibt einen Ausblick auf mögliche zukünftige Entwicklungen.
Keywords	Diffusion Tensor Imaging ; zervikale Myelopathie ; Prädiktor ; Operation ; Diffusion Tensor Imaging ; cervical myelopathy ; predictive factor ; surgery
Language	German
Publishing date	2020-10-29
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2509-825X ; 2509-8241
ISSN (online)	2509-825X
ISSN	2509-8241
DOI	10.1055/a-1169-0990
Database	Thieme publisher's database

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Article ; Online: Interleukin-6 as inflammatory marker of surgical site infection following spinal surgery.

Lenski, Markus / Tonn, Joerg-Christian / Siller, Sebastian

Acta neurochirurgica

2020 Volume 163, Issue 6, Page(s) 1583–1592

Abstract: Background: In order to elucidate whether serum inflammatory markers identify patients with local surgical site infection(SSI) as underlying disease for recurrent or new symptomatology following spine surgery, we evaluated the diagnostic potential of ... ...

Abstract	Background: In order to elucidate whether serum inflammatory markers identify patients with local surgical site infection(SSI) as underlying disease for recurrent or new symptomatology following spine surgery, we evaluated the diagnostic potential of interleukin-6(IL-6) as a marker of SSI. The diagnostic significance of IL-6 was compared to the standard serum inflammatory markers C-reactive protein(CRP) and white blood cell count (WBCC). Method: Ninety-eight consecutive patients with readmission due to recurrent or new symptomology after spinal surgery of degenerative spine disorders entered the study. Baseline patients' characteristics and the abovementioned inflammatory markers were collected, and arithmetical means with standard deviation, area under the curve (AUC), thresholds, sensitivity, specificity, positive(+)likelihood ratio (LR), and negative(-)LR with corresponding 95% confidence interval(95%CI) were calculated and correlated with presence or absence of SSI. Results: Nine patients suffered from a SSI, whereas the remaining 89 patients had a recurrent/adjacent-segment degenerative disorder without evidence of infection. The most significant parameter for diagnosing a SSI was serum IL-6 (cut-off value > 15.3 pg/ml, AUC = 0.954, SE = 85.7%, SP = 97.3%), followed by CRP (cut-off value = 0.8 mg/dl, AUC = 0.916, SE = 88.9%, SP = 84.5%) CONCLUSIONS: In the case of recurrent or new symptomatology following spinal surgery, serum IL-6 has the highest diagnostic potential for diagnosing spinal SSI.
MeSH term(s)	Adult ; Aged ; Biomarkers/blood ; C-Reactive Protein/analysis ; Humans ; Interleukin-6/blood ; Male ; Middle Aged ; Neurosurgical Procedures/adverse effects ; Spine/surgery ; Surgical Wound Infection/blood ; Surgical Wound Infection/diagnosis
Chemical Substances	Biomarkers ; Interleukin-6 ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2020-10-29
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-020-04628-8
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Book ; Online ; Thesis: Vergleich der TLR9-abhängigen Aktivierung von Transkriptionsfaktoren in intestinalen Immunzellen unter gesunden und chronisch entzündlichen Bedingungen

Siller, Sebastian

2014

Author's details	vorgelegt von Sebastian Siller
Language	German
Size	Online-Ressource, Ill., graph. Darst.
Document type	Book ; Online ; Thesis
Thesis / German Habilitation thesis	Univ., Diss.--Regensburg, 2015
Database	Former special subject collection: coastal and deep sea fishing

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Article ; Online: Intramedullary spinal cord cavernous malformations-association between intraoperative neurophysiological monitoring changes and neurological outcome.

Niedermeyer, Sebastian / Szelenyi, Andrea / Schichor, Christian / Tonn, Joerg-Christian / Siller, Sebastian

Acta neurochirurgica

2022 Volume 164, Issue 10, Page(s) 2595–2604

Abstract: Background: Microsurgical resection of spinal cord cavernous malformations can be assisted by intraoperative neurophysiological monitoring (IONM). While the clinical outcome after surgical resection has been discussed in several case series, the ... ...

Abstract	Background: Microsurgical resection of spinal cord cavernous malformations can be assisted by intraoperative neurophysiological monitoring (IONM). While the clinical outcome after surgical resection has been discussed in several case series, the association of intraoperative IONM changes and detailed neurological outcome, however, has not been analyzed so far. Methods: Seventeen patients with spinal cavernomas underwent surgery between 02/2004 and 06/2020. Detailed neurological and clinical outcome as well as IONM data including motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring were retrospectively analyzed. Intraoperative IONM changes were compared to outcome at 3-month and 1-year follow-up in order to identify surrogate parameters for an impending neurological deficit. Results: Compared to the preoperative state, McCormick score at 1-year follow-up remained unchanged in 12 and improved in five patients, none worsened, while detailed neurological examination revealed a new or worsened sensorimotor deficit in 4 patients. The permanent 80% amplitude reduction of MEP and 50% amplitude reduction of SSEP showed the best diagnostic accuracy with a sensitivity of 100% and 67% respectively and a specificity of 73% and 93% respectively. The relative risk for a new neurological deficit at 1-year follow-up, when reversible IONM-deterioration was registered compared to irreversible IONM deterioration, was 0.56 (0.23-1.37) for MEP deterioration and 0.4 (0.18-0.89) for SSEP deterioration. Conclusions: Reversible IONM changes were associated with a better neurological outcome at follow-up compared to irreversible IONM deterioration during SCCM surgery. Our study favors the permanent 80% amplitude reduction criterion for MEP and 50% amplitude reduction criterion for SSEP for further prospective evaluation of IONM significance and the effectiveness of corrective maneuvers during SCCM surgeries.
MeSH term(s)	Evoked Potentials, Motor/physiology ; Evoked Potentials, Somatosensory/physiology ; Humans ; Intraoperative Neurophysiological Monitoring ; Retrospective Studies ; Spinal Cord Neoplasms/surgery
Language	English
Publishing date	2022-09-06
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-022-05354-z
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